Moderne neurophysiologische Therapiestrategien zur Behandlung motorischer Handfunktionsstörungen nach Schlaganfall

 

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Zusammenfassung

Mit modernen neurophysiologischen Stimulationstechniken, wie der repetitiven transkraniellen Magnetstimulation und der transkraniellen Gleichstromstimulation, kann die Erregbarkeit der Hirnrinde in Abhängigkeit von den gewählten Stimulationsparametern für mehrere Minuten reduziert (Inhibition) oder erhöht (Fazilitation) werden. Die zielgerichtete Modulation der Erregbarkeit der Hirnrinde kann plastische Änderungen innerhalb des Netzwerkes sensomotorischer Hirnrindenareale induzieren, wodurch auch pathologische Anpassungsprozesse, zum Beispiel infolge eines Schlaganfalls, positiv beeinflusst werden können. Die therapeutische Anwendung transkranieller hirnstimulierender Verfahren gründet sich im Wesentlichen auf die Hypothese der interhemisphärischen Kompetition. Die Arbeit gibt einen Überblick über die Anwendung von repetitiver transkranieller Magnetstimulation und transkranieller Gleichstromstimulation in der Behandlung von Handfunktionsstörungen nach Schlaganfall.

Abstract

Modern neurophysiological brain stimulation techniques, such as transcranial magnetic stimulation and direct current stimulation, are powerful tools to inhibit or facilitate cortical excitability for several minutes after stimulation depending on the stimulation parameters used. Purposeful modulation of cortical excitability may induce plastic changes within the cortical network of sensorimotor areas, and has the power to improve the function of the affected hand after stroke. The therapeutic use of transcranial brain stimulation techniques is based on the concept of interhemispheric competition. Here we give an overview of the use of repetitive transcranial magnetic stimulation and direct current stimulation in the rehabilitation of impaired hand function after stroke.

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1 Der Begriff Schlaganfall umfasst ätiologisch sowohl die zerebrale Ischämie als auch die intrazerebrale Blutung. Im Folgenden wird der Begriff Schlaganfall stellvertretend für die zerebrale Ischämie verwendet.

Priv-Doz. Dr. Dennis A. Nowak

Neurologische Klinik und Poliklinik, Klinikum der Universität zu Köln

Kerpener Straße 62

50924 Köln

Email: dennis.nowak@uk-koeln.de